Biology of Head and Neck Cancer


Ezra Cohen, MD: Thank you for joining this OncLive Peer Exchange® entitled, “Advanced Head and Neck Cancers: Looking Forward.” We have entered a new era in the treatment of squamous cell carcinoma of the head and neck, owing to improved insight surrounding the underlying biology of this disease and new advances in therapeutic targeting of the immune system. This expert panel discussion will focus on strategies for refining treatment of advanced disease and improving outcomes after recurrence. We’ll provide perspective on the latest research findings and their application to clinical practice.

I am Dr. Ezra Cohen, and I am a professor of medicine for the Division of Hematology/Oncology, Department of Medicine at UC San Diego, and the co-director of the Center for Precision Immunotherapy. Joining me for this discussion are Dr. Joshua Bauml, assistant professor of medicine at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia; Dr. Barbara Burtness, professor of medicine at the Yale University of Medicine and co-leader of the Developmental Therapeutics Research Program at Yale Cancer Center in New Haven, Connecticut; and Dr. Jared Weiss, an assistant professor of medicine and section chief of Thoracic and Head/Neck Oncology at UNC in Chapel Hill, North Carolina. Thank you for joining us.

Let’s first start by talking about the biology and the stratification for patients with head and neck squamous cell carcinoma. Josh, take us through a little bit about the underlying biology of this disease.

Joshua M. Bauml, MD: Absolutely. Thanks so much, Ezra. Head and neck cancer used to be a relatively homogenous disease. It was caused largely by exposure to tobacco and alcohol. But now we’re seeing more and more subgroups for head and neck cancer. The one that is affecting most Americans is human papillomavirus, or HPV. At this point, it is the leading cause of oropharyngeal head and neck cancer, and patients with HPV-associated head and neck cancers have a different epidemiology. They tend to be younger, they tend to be healthier, and they have a much better prognosis.

At this point, though, HPV—or, as it’s measured by its surrogate marker, P16 positivity—is only a prognostic marker; it’s not used as a predictive marker to choose the treatment. But still, it harkens to the idea that maybe we should be treating these patients differently, given their underlying biology. And some emerging data are finding that…

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